Fertility

Each month the ovary usually produces at least one egg that matures and is released to be picked up by the Fallopian tube.

Many conditions can prevent ovulation occurring.

• Polycystic Ovaries
• Premature ovarian failure
• Exercise related amenorrhoea
• Thyroid disease
• Pituitary disease
  • Hyperprolactinaemia
• Hypothalamic disease
  • Hypothalamic failure
  • Kallman’s disease
  • Weight related amenorrhoea

Management

Treatment is targeted at treating specific problems, for example correction of hormone imbalances and making lifestyle changes to restore ovulation.  Sometimes ovulation can be restored using tablets such as clomid or letrozole.  Mr Lower is also happy working with complementary therapists using modalities such as acupuncture.

In some conditions ovulation cannot be restrored, for example in cases of premature ovarian failure. In such cases Mr Lower recommends egg donation. He has worked closely with Shady Grove Fertility Centre in the US. They offer a shared risk protocol for many of their patients, where there is a larger up front cost, but they will offer as many cycles as is required to have a baby. If you do not have a live baby as a result of treatment they will offer a refund of the fees. In the last 20 years Mr Lower has only had one patient who has needed a refund from Shady Grove.

The Fallopian tubes are very fragile structures and are susceptible to damage from:

• Infection
• Previous Surgery
• Endometriosis

The most common infection to cause tubal damage is Chlamydia.  Gonorrhoea is less common but equally damaging.  Generalised pelvic infection from the appendix or damage to the bowel can also result in scarring around the Fallopian tubes.

Previous operations, for example for ovarian cysts or ectopic pregnancy, can also lead to damage to the Fallopian tube by scarring, limiting their ability to pick up the egg when it is released from the ovary.

Endometriosis is known to be associated with infertility, but we are still not sure of the exact cause.  It is unusual for the Fallopian tubes to be blocked unless there has been previous surgery.

Management

Sometimes, it is possible to repair the damage to the Fallopian tubes using laparoscopic surgery, where a narrow telescope is introduced through the skin of the abdominal wall at the umbilicus or belly button.  With a further 2 small incisions on the bikini line, instruments such as scissors or a surgical laser can be used to remove the adhesions and restore the function of the Fallopian tubes. 

This is a condition where the endometrium (the tissue lining the uterus) grows outside the uterus.  It can grow on the ovaries where it may form cysts, the bowel, the lining of the abdominal cavity, the bladder and even in the pleural cavity around the lungs.

Endometriosis can interfere with natural conception, but the exact mechanism is unclear.  The good news is that endometriosis does not seem to adversely affect the chances of conceiving with IVF.

Management

Laparoscopic treatment using a surgical laser to ablate the endometriosis can lead to up to 60% pregnancy rate in the first year after surgery. This treatment can also lead to a reduction in the symptoms of endometriosis such as heavy and painful periods and pain with sex. Mr Lower is highly experienced in this surgery and often recommends it, particularly for younger women where there is less concern for diminishing ovarian reserve.

These are benign tumours which grow in the wall of the uterus.  Submucosal and intramural fibroids can interfere with the process of implantation and cause early miscarriage and can reduce the chance of conception by up to 50%.

Management

The only successful way to treat fibroids that are adversely affecting fertility is by surgery. Provided the fibroids are not too big they can be removed using laparoscopic or hysteroscopic surgery.  Open surgery may be required for larger fibroids. Mr Lower is a renowned expert in the surgical treatment of fibroids.  He is also now offering a new outpatient treatment for fibroids called Sonata, where a radio frequency probe is introduced into the uterus under ultrasound control. The radio frequency energy heats and thus shrinks the fibroids. For more information follow this link.

Around 20% of all cases of infertility have a predominantly male factor.  The sperm have to swim from the vagina through the uterus and up the Fallopian tubes to meet the egg.  Any defect of the sperm including shape and motility (swimming ability) means that fewer sperm will arrive in the Fallopian tubes.  The sperm duct in the man (vas deferens) can be blocked by infection, surgery or as a birth abnormality.  This blockage leads to absence of sperm in the ejaculate (azoospermia).  Mr Lower does not treat men himself, but refers to colleagues with particular expertise in this area – Andrologists.  

Management

Andrologists may recommend treatment of underlying medical and hormonal issues or sometimes surgery to improve the sperm count and function.  Unfortunately it can take many weeks before the sperm count returns to normal and there is often concern about the age of the woman.  Where such concerns exist, IVF with ICSI can often achieve a successful conception sooner than trying naturally.